The Worldwide Challenge of Diabetes
Creating a Response Worth Imitating
September 20, 2010
Daniel M. Bradbury
There has long been a certain “prestige” in many parts of the developing world associated with adopting a Western lifestyle.
In recent decades, in countries where industrialization and Western diets are on the rise, the lure of imitating life in the West remains an undeniably strong force, even as the downside of these changes becomes glaringly clear. While China recently surpassed Japan as the world’s second largest economy, it was also gaining ground in a competition that no country wants to win as it passed India to become the country with the most cases of diabetes in the world.
As diabetes continues its inexorable march across the globe, it is exceptionally difficult to find a positive message amid a litany of grim statistics. The World Health Organization predicts the 170 million cases of diabetes in 2000 will have grown to 366 million by 2030, more than three-quarters of which will reside in developing countries.
In Europe, where this week 16,000 diabetes researchers, clinicians, and others are gathering for the annual meeting of the European Association for the Study of Diabetes, there has been broad agreement at the highest levels of government for at least the past 20 years about what needs to be done to stop the rise of diabetes. As far back as 1989, participants from around the world converged in Italy and developed the St. Vincent Declaration, kick-starting a process to encourage countries to adopt policy approaches that deal aggressively with the problem of diabetes.
Although this and other large-scale efforts have not yet slowed the explosive growth of diabetes, they have been effective at raising awareness and keeping the issue on the front burner. Further, they have led to the promulgation of blueprints that can serve as a model for countries that are suddenly grappling with a daunting public health crisis.
The optimistic thread that runs through all of these efforts is the acknowledgement that, despite the track record, the progression to type 2 diabetes is not an inevitable one. An individual can delay or prevent type 2 diabetes altogether through timely interventions and quality medical care. Among those who have progressed to diabetes, the prognosis is better than ever thanks to improved medicines and knowledge about how best to use them.
As clinicians from across Europe and around the world gather this week in Stockholm, it is worth reminding ourselves that we in the US and Western Europe – who have always been in the vanguard with diabetes – now have an opportunity to lead by example as the rest of the world confronts this problem.
In the US, it is critical that we elevate the importance of prevention throughout the healthcare system. We must also work to ensure that patients who progress to type 2 diabetes receive aggressive disease management services and broad access to a range of therapeutic options as I discussed in this article (Healthcare Reform, June 9, 2010).
In Europe some pilot efforts based on this type of comprehensive approach provide an early test case of what can be achieved. One notable example is the Development Programme for the Prevention and Care of Diabetes (DEHKO) in Finland, which has been tracking quantifiable progress over the past decade toward three key goals: prevention of type 2 diabetes; improvements in the quality of diabetes care; and support of self-care of persons with diabetes. Evaluation of the program is ongoing, and so far the results are encouraging.
In the end, governments large and small that adopt a comprehensive approach to preventing and managing diabetes will discover that this policy makes as much health sense as it does economic sense.
If we in the West can begin to lead in a new direction, we might find that the perception of what’s “prestigious” begins to change… for the better.
Dan Bradbury is President and Chief Executive Officer, Amylin Pharmaceuticals.
For more related articles, click Diabetes Perspectives.